Tibial Eminence Fracture and Pediatric ACL Avulsion Diagnosis and Treatment: A Case Report

Abstract

Introduction: Tibial eminence fractures resulting from the avulsion of the anterior cruciate ligament (ACL) insertion are a common knee injury in the pediatric population. This injury is traditionally corrected through internal fixation using a guide pin and a cannulated screw. Due to the reported consequences of cannulated screws impinging on the joint space, we explored an alternative procedure to address this injury without the use of cannulated screws. We believe this is the first report of an alternate and improved procedure for repairing a tibial eminence fracture caused by ACL avulsion using non-absorbable sutures to secure the bony fragment back onto the tibial eminence. Case Report: We report the diagnosis, treatment, and follow-up of a 15-year-old Caucasian male who suffered a tibial eminence fracture associated with an ACL avulsion following a tackle football injury. We utilized a new all-arthroscopic procedure that involved securing the bony fragment of the tibial eminence using sutures that were passed through the ACL and proximal tibial using interosseous bone tunnels. Conclusion: This novel procedure successfully eliminates the need for intra-articular screws in the adolescent knee while treating tibial avulsion fractures - as supported by the patient’s marked radiographical and symptomatic improvement at the 2, 6, and 12-week follow-up visits. Keywords: Anterior cruciate ligament, tibial eminence, pediatrics.